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While I know that the discussion of oral sex and HIV transmission is a sore spot for many on this message board, the article above points out that there is still risk. This article is from poz.com.

I'm only posting it because it is my opinion that the aidsmeds moderators should change the "official" aidsmeds.com "stance" on oral sex and HIV transmission. It is low risk not no risk, there is a huge difference. Even if the risk is theoretical, then we should say it is theoretical but we should not state that risk is completely absent. People should have the opportunity to get the correct information here.

Many forum members, of course, have their own opinions. Is there a particular discussion or thread which you are referring to?

Regards,

Henry

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"Life in Lubbock, Texas, taught me two things: One is that God loves you and you're going to burn in hell. The other is that sex is the most awful, filthy thing on earth and you should save it for someone you love." - Butch Hancock, Musician, The Flatlanders

Indeed. Some of us have deducted that there is no other likely route of transmission for our own infection. But take it from me, this particular discussion leads nowhere; opinions are far too entrenched, probably partly because so much is at stake.

And as the primary author of the sexual transmission information posted on both POZ.com and AIDSmeds.com (including an even more detailed lesson here: http://www.aidsmeds.com/articles/Transmission_9960.shtml). you certainly won't catch me saying that there's 'no risk' associated with oral sex. In the article, we indicate that there HAVE been cases of HIV transmission via oral sex -- we even spell out the circumstances by which individuals, participating in transmission studies, were most likely to be infected via oral sex.

Here's our official stance on the subject:

Of the different sex acts, the one that often causes the greatest amount of confusion in terms of risk – and raises the greatest number of questions – is penile-oral sex. The fact is, most experts agree that fellatio, sometimes referred to as "blow jobs," is not an efficient route of HIV transmission. However, this does not mean that it cannot happen.

Research attempting to evaluate the risk of fellatio has often faced important limitations. For starters, very few people participating in studies only engaged in penile-oral sex. Many people also had unprotected vaginal or anal intercourse, making it very difficult to determine if unprotected fellatio is an "independent factor" associated with HIV transmission. There are also people who test positive for HIV and claim that unprotected fellatio was their only risky behavior. However, it's virtually impossible to know if these people are always reporting their sexual behavior accurately. (Study volunteers often have a difficult time admitting the truth about potentially embarrassing behavior to healthcare professionals conducting scientific studies.)

Because unprotected fellatio can mean that body fluids from one person can (and do) come into contact with the mucosal tissues or open cuts, sores, or breaks in the skin of another person, there is a "theoretical risk" of HIV transmission. "Theoretical risk" means that passing an infection from one person to another is considered possible, even though there haven't been any (or only a few) documented cases. This term can be used to differentiate from documented risks. Having unprotected receptive anal or vaginal intercourse with an HIV-positive partner is a documented risk, as they have been shown in numerous studies to be an independent risk factor for HIV infection. Having unprotected oral sex is a theoretical risk, as it is considered possible, but has never been shown to be an independent risk factor for HIV infection.

Here's a good way to think about theoretical risk: In theory, it is possible that while walking down the street, a meteor will fall on your head and kill you instantly. This is because meteors do occasionally fall to earth. People live their lives above ground, so there is a theoretical risk of being hit be a meteor. In fact, there have been reports of a few people being hit by meteors. But because the risk is so small, given that few meteors fall to earth and the large number of inhabitants of this planet, the risk is purely theoretical. The same principle holds true with oral sex – millions of people all over the world are believed to engage in unprotected oral sex and there have only been a handful of documented cases of HIV transmission. In turn, fellatio, and other types of oral sex (see below), remains a theoretical risk for HIV infection.

There have been a number of studies that have closely followed MSM and heterosexual couples, in which one partner was HIV positive and the other partner was HIV negative. In all of the studies, couples that used condoms consistently and correctly during every experience of vaginal or anal sex – but didn't use condoms during oral sex – did not see HIV spread from the HIV positive partner to the HIV negative partner.

There have been three case reports and a few studies suggesting that some people have been infected with HIV as a result of unprotected oral sex. However, these case reports and studies all involved MSM – men who were the receptive partners (the person doing the "sucking") during unprotected oral sex with another HIV-positive man. There haven't been any case reports or studies documenting HIV infection among female receptive partners during unprotected oral sex. Even more importantly, there hasn't been a single documented case of HIV transmission to an insertive partner (the person being "sucked") during unprotected oral sex, either among MSM or heterosexuals.

Is insertive oral sex a possible route of HIV transmission? Yes. But is it a documented risk? Absolutely not.

Nothing we've written here -- or advocated in these Forums -- contradicts ACOG's recommendation. It is a low-risk activity that all sexually active individuals should consider the grand scheme of things.

As far as "nobody" liking to talk about it, some members here can't seem to get enough. And the end result is always the same. Science versus anecdote. And With three long-term studies behind us thus far, science really does seem to have a distinct advantage. I certainly do not intend to debate this with you again. Apparently, it seems to go nowhere.... until you decide to spring it back to life again as though nothing was said.

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

Sara tried to address the potential for deflecting rather than receiving an e-mail like yours, but it arrived regardless.Very regardless. While I know that the discussion of oral sex and HIV transmission is a sore spot for many on this message board, the article above points out that there is still risk.

Henry, Matt and Tim saw fit to answer Sara with out coming up with a line she didn't write as you included. As far as "nobody" liking to talk about it,...

And, they managed to handle their answers in such a way as to not sound haughty.Goodness, oral sex DOES seem to be a sticking point with you, does it not?

Can't you just put Sara's posts on Ignore and walk away? Why do you have to scour her past threads for proof of your assertions. I would think such time would be better spent stroking a ferret, reading a book, or listening to classical music or doing all three at the same time.

Sara is a very bright woman who would readily concede that this is a concern of hers. And she ought to be able to pursue her questions and concerns without such treatment from you.

I am so confident I don't even have to go looking for proof that Sara would never write to you as you have to her.

The title of the thread as well as the first statement pretty much sets up for criticism. Maybe it should have been written as "I have a concern...." instead of being a bit passive aggressive.

modified for typo

well I never heard of the subject of Oral Sex being referred to as "Passive Aggressive".........that's WAY too Funny when you think about it, thought I'd just inject some humor in here, you all are way too clinical and Serious for my taste but it did make me laugh......Thanks for making my day

« Last Edit: September 15, 2008, 07:58:41 PM by denb45 »

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"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Can't you just put Sara's posts on Ignore and walk away? Why do you have to scour her past threads for proof of your assertions. I would think such time would be better spent stroking a ferret, reading a book, or listening to classical music or doing all three at the same time.[/color]

While I know that the discussion of oral sex and HIV transmission is a sore spot for many on this message board, the article above points out that there is still risk. This article is from poz.com.

I'm only posting it because it is my opinion that the aidsmeds moderators should change the "official" aidsmeds.com "stance" on oral sex and HIV transmission. It is low risk not no risk, there is a huge difference. Even if the risk is theoretical, then we should say it is theoretical but we should not state that risk is completely absent. People should have the opportunity to get the correct information here.

Sara

Sara, oral sex is considered very low risk behavior because HIV is inhibited by saliva and wiped out by stomach acid.

Is there a risk? Sure, theoretically. But I stand a better chance of getting run over trying to cross a street in Mexico City than I do catching HIV via oral sex.

There is a theoretical risk, sure, but that's a far cry from the risk associated with unprotected anal or vaginal sex. Hence, it is often recommended as a form of harm reduction for those who eschew condoms. That goes for the straights and the gays, by the way, because females actually practice a lot more anal sex than people realize or are willing to talk about.

Sara tried to address the potential for deflecting rather than receiving an e-mail like yours, but it arrived regardless.Very regardless. While I know that the discussion of oral sex and HIV transmission is a sore spot for many on this message board, the article above points out that there is still risk.

Henry, Matt and Tim saw fit to answer Sara with out coming up with a line she didn't write as you included. As far as "nobody" liking to talk about it,...

And, they managed to handle their answers in such a way as to not sound haughty.Goodness, oral sex DOES seem to be a sticking point with you, does it not?

Can't you just put Sara's posts on Ignore and walk away? Why do you have to scour her past threads for proof of your assertions. I would think such time would be better spent stroking a ferret, reading a book, or listening to classical music or doing all three at the same time.

Sara is a very bright woman who would readily concede that this is a concern of hers. And she ought to be able to pursue her questions and concerns without such treatment from you.

I am so confident I don't even have to go looking for proof that Sara would never write to you as you have to her.

Em

With respect Em this is why some threads end up looking like a battle field, I don't know how many times we have to say this, please stick to responding to the OP..and not to those who respond..it doesn't help the OP, in fact 9 times out of 10 the OP gets forgotten about because everyone is too busy having a go at those who respond..and I don't see how that could possibly help the OP..do you?

As you say Sara is a very bright women, she can stick up for herself and respond to JK in the way she wants to...if indeed she feels the need to.

"Theoretical risk" means that it could happen but hasn't yet. The day I can imagine a blowjob totally bereft of saliva is the day I'll take the risk of oral sex more seriously when discussing risk assessment over at AII.

Something that hasn't been addressed is why this red-button topic gets wheeled out as often as it does. It seems to me as though there are three likely reasons:

1) There is a genuine scientific curiosity about potential risk factors, pursued with an open, questioning mind that has not yet formed an opinion one way or the other; or there is a lingering doubt that after over 25 years of study, not all avenues of potential infection are known yet. The former is the very basis of scientific method; the latter would require a number of proven "mystery cases" that haven't yet been discovered.

2) There is a distrust of the scientific method, in as much as after 25 years study the risk of oral sex remains "theoretical" and not "extremely low". Given how poorly science is taught in schools in the US and elsewhere, and the degree to which such scientific paradigms as evolution are ridiculed by certain "culture warriors", this is sad but understandable.

3) There is some need to further separate infections into categories beyond the various demographics already recognized: gender, racial, economic, etc. Every time the pie gets sliced again, little bits of stigma are deflected or reinforced, which is (rightly) perceived by the majority of people concerned with HIV/AIDS as self-defeating, especially when it's used (as it always is) to "divide and conquer".

Part of reason #3 bothers me is that it involves an internalized stigma that wishes to distance cocksuckers from bottoms, as if there's some added shame in being fucked (or perhaps it's restricted to "only" being fucked without a condom, the suggestion being that having unprotected sex is "stupid" or "self-destructive"). For gay men, this is erroneous and self-depreciating, but for women it's incomprehensible.

/modified for clarity/

« Last Edit: September 16, 2008, 12:04:08 PM by Bucko »

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Part of reason #3 bothers me is that it involves an internalized stigma that wishes to distance cocksuckers from bottoms, as if there's some added shame in being fucked (or perhaps it's restricted to "only" being fucked without a condom, the suggestion being that having unprotected sex is "stupid" or "self-destructive"). For gay men, this is erroneous and self-depreciating, but for women it's incomprehensible.

I'll take this further, at least in the context of this web forum: even if we were to accept that one or two individuals got infected via oral sex (which is probably being generous, but let's just pretend for a moment), inevitably when the topic is brought up magically out trots at least a dozen or more individuals, further reinforcing what you just stated in my mind (not to mention that when they reveal details the "stories" are full of holes).

I'll take this further, at least in the context of this web forum: even if we were to accept that one or two individuals got infected via oral sex (which is probably being generous, but let's just pretend for a moment), inevitably when the topic is brought up magically out trots at least a dozen or more individuals, further reinforcing what you just stated in my mind (not to mention that when they reveal details the "stories" are full of holes).

And along with these "anecdotalists" comes their enablers. And quick on their heels are the sexual prohibitionists. There's no lack of desire to discuss this issue: it's just a lack of enthusiasm for what has become the inevitable pattern. Lots of heat gets expended, but ultimately everyone just retrenches. It's divisive and futile.

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

"Theoretical risk" means that passing an infection from one person to another is considered possible, even though there haven't been any (or only a few) documented cases.

Maybe the problem here is the use of the term "theoretical risk" regarding receptive oral sex (I guess all of us agree insertive oral sex carries no risk of hiv transmission).

For some, "theoretical risk" equals to "is never ever gonna happen in real life", for others "theoretical risk" means "extremely low risk but I might have been the one". Of course there is a vested interest in some people supporting either one: for some of the ones who support the first view, the interest is having a green ethical light to not disclose when having sex as long as anal/vaginal is protected; for some of the ones who support the second, it's a "holier than thou" feeling that helps them salvage their fragile self worth.

What I don't understand is why this such a hot issue. Well, I suppose it makes sense for those who think that they got it from oral sex, after all, if someone challenges that belief, that someone is claiming to know better than themselves the risks they undertook.

But why is this so controversial to those who don't believe in transmission through oral sex? I think they've internalized too that absurd caste system of hivers, otherwise they wouldn't even bat their eyes when someone says he got it through oral.

Maybe the problem here is the use of the term "theoretical risk" regarding receptive oral sex (I guess all of us agree insertive oral sex carries no risk of hiv transmission).

For some, "theoretical risk" equals to "is never ever gonna happen in real life", for others "theoretical risk" means "extremely low risk but I might have been the one". Of course there is a vested interest in some people supporting either one: for some of the ones who support the first view, the interest is having a green ethical light to not disclose when having sex as long as anal/vaginal is protected; for some of the ones who support the second, it's a "holier than thou" feeling that helps them salvage their fragile self worth.

Anyone who isn't clear on the fact that "hypothetical" means that it hasn't happened yet would seem to have a problem understanding English. "Hypothetical risk" is not the same as "very low risk": words have meaning.

What I don't understand is why this such a hot issue. Well, I suppose it makes sense for those who think that they got it from oral sex, after all, if someone challenges that belief, that someone is claiming to know better than themselves the risks they undertook.

But why is this so controversial to those who don't believe in transmission through oral sex? I think they've internalized too that absurd caste system of hivers, otherwise they wouldn't even bat their eyes when someone says he got it through oral.

Edit: typo

I have no interest in promulgating any "caste system"; I'm actually fighting against it. Nothing gets my dander in a ruff quite like hearing of an "innocent victim" with HIV. It's not for a second that I doubt whether or not someone was infected "innocently", it's that I don't believe the opposite, which is that some people merit their infection. I honestly believe that we're all in this together, and separating us into groups diminishes our solidarity.

My main interest in holding up the scientific side of the argument is that I believe that knowledge equals power. I would not want my doctor holding emotional opinions in greater importance than scientific ones regarding my care. And it pains me personally to see supposition and anecdote give the same weight as scientific data.

I also have a very real stake in creating a counterpoint to sexual prohibitionism. Having lived with the consequences of guilt and shame over having been infected with HIV, I gladly drank that KoolAid for years to the detriment of my well-being, physically, mentally and emotionally. If I can help someone else negotiate his/her way through that minefield I will.

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Anyone who isn't clear on the fact that "hypothetical" means that it hasn't happened yet would seem to have a problem understanding English. "Hypothetical risk" is not the same as "very low risk": words have meaning.

No offence, but the same could be said of anyone who thinks that theoretical risk means that it hasn't ever occurred. Theoretical simply means that there has been no clearly documented case of it occurring. Given the minuscule fraction of one percent of transmissions which are ever investigated in any detail, and where there isn't at least the possibility that transmission could have occurred by some other means, it would also be quite remarkable if a case ever was convincingly documented.

Don't get me wrong here, I am absolutely not in favour of over-egging the risks of oral sex; but let's not head off to the diametrically opposite extreme in order to try to belittle those we don't agree with.

Oh, and by the way, it is also totally wrong to state that a "hypothetical risk" means that it hasn't happened: it means that the theoretical risk is there but that the theoretical risk does not necessarily translate into a risk which is real or true.

No offence, but the same could be said of anyone who thinks that theoretical risk means that it hasn't ever occurred. Theoretical simply means that there has been no clearly documented case of it occurring. Given the minuscule fraction of one percent of transmissions which are ever investigated in any detail, and where there isn't at least the possibility that transmission could have occurred by some other means, it would also be quite remarkable if a case ever was convincingly documented.

Oh, and by the way, it is also totally wrong to state that a "hypothetical risk" means that it hasn't happened: it means that the theoretical risk is there but that the theoretical risk does not necessarily translate into a risk which is real or true.

The central point is that a hypothesis is an unproven supposition. If it were proven, it would be a fact. The fact is that we are the most monitored medical group in history. If there were any real proof that unprotected oral sex led to transmission of HIV, it would be published. The pandemic is in its third decade...where is the proof?

Edited to add: "theory" and "hypothesis" are considered synonymous according the sources I've consulted.

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Anyone who isn't clear on the fact that "hypothetical" means that it hasn't happened yet would seem to have a problem understanding English. "Hypothetical risk" is not the same as "very low risk": words have meaning.

Yes, and "theoretical" isn't the exactly the same as "hypothetical". Though both are very close in meaning, the former implies that it complies with the current general theory of how hiv is transmitted, though in practice it may or may not happen, the later implies something is just conjectural. And hypothesis is not something meant to be proven true or false.

Neither do I. We're all in this together. Someone who got it though needle sharing is no better or worse than a kid that got it from his mother, for example. Transmission happens because a situation where it can occurs. It's not a question of guilt. No more than getting a common cold.

My main interest in holding up the scientific side of the argument is that I believe that knowledge equals power. I would not want my doctor holding emotional opinions in greater importance than scientific ones regarding my care. And it pains me personally to see supposition and anecdote give the same weight as scientific data.

The problem is there is that right now, there is no scientific argument that assures whether the risk is real or not. We only know it's theoretically possible, given what we know of how hiv is transmitted, but so far it has not be proven if it happens or not in real life. You choose to believe it has not be proven because it doesn't happen, but that's a decision you've had to made (an informed, and in my opinion respectable decision), not something stated by science. Things are quite different for example with insertive oral sex, that isn't even a theoretical risk.

I also have a very real stake in creating a counterpoint to sexual prohibitionism.

I don't think that whether you believe there is no risk or just a extremely small one attached to oral sex has anything to do with sexual prohibitionism... In any case you can have as much protected sex as you want. You can be sure I do

The central point is that a hypothesis is an unproven supposition. If it were proven, it would be a fact. The fact is that we are the most monitored medical group in history. If there were any real proof that unprotected oral sex led to transmission of HIV, it would be published. The pandemic is in its third decade...where is the proof?

Edited to add: "theory" and "hypothesis" are considered synonymous according the sources I've consulted.

Sorry, but even those references (poor as they are) still don't support what you are saying - and when did unproven (i.e. something that is not indisputably the case) become synonymous with untrue?

Evidence has been published, but it isn't conclusive and doesn't prove beyond doubt. That doesn't mean it is untrue - and it most certainly doesn't mean that it hasn't happened - it just means that it remains unproven theory and that the risk is still hypothetical (i.e. possible real, but not necessarily so).

Given good oral hygiene, I don't for a single moment think that the risks of oral sex are anything other than infinitesimally small and hypothetical; but if anyone says that no-one has ever been infected through oral sex, then I will call them on it and challenge them to show me even a single credible peer-reviewed source which states anything of the kind (and if you can't back it up, then it is totally irresponsible to say it).

I also happen to think that Aidsmeds, and all credible online resources I can think of, state the risk in its proper context.

Sorry, but even those references (poor as they are) still don't support what you are saying - and when did unproven (i.e. something that is not indisputably the case) become synonymous with untrue?

Evidence has been published, but it isn't conclusive and doesn't prove beyond doubt. That doesn't mean it is untrue - and it most certainly doesn't mean that it hasn't happened - it just means that it remains unproven theory and that the risk is still hypothetical (i.e. possible real, but not necessarily so).

Given good oral hygiene, I don't for a single moment think that the risks of oral sex are anything other than infinitesimally small and hypothetical; but if anyone says that no-one has ever been infected through oral sex, then I will call them on it and challenge them to show me even a single credible peer-reviewed source which states anything of the kind (and if you can't back it up, then it is totally irresponsible to say it).

I also happen to think that Aidsmeds, and all credible online resources I can think of, state the risk in its proper context.

The same can be said of Bigfoot and alien abduction, Finn.

The possibility (or hypothesis) of risk is not the same as a measurable risk. If it's not possible to quantify or even properly state a risk as it applies to real life, then, yes...it's Bigfoot territory. There is, after all, no solid proof that there is no such creature, and there are thousands of people insisting that it's real.

And you'll never find any scientific document anywhere that states conclusively that Bigfoot doesn't exist.

The problem is there is that right now, there is no scientific argument that assures whether the risk is real or not. We only know it's theoretically possible, given what we know of how hiv is transmitted, but so far it has not be proven if it happens or not in real life. You choose to believe it has not be proven because it doesn't happen, but that's a decision you've had to made (an informed, and in my opinion respectable decision), not something stated by science. Things are quite different for example with insertive oral sex, that isn't even a theoretical risk.

There actually is sound scientific documentation regarding the transmission of HIV. We know that it is passed through unprotected anal or vaginal sex between serodiscordant partners. This understanding was not arrived at willy-nilly: it's based on sound scientific documentation. The same can be said for insertive oral. But if, after tracking the evolution of the pandemic since 1981, there are no confirmed cases of transmission through giving a blowjob, it seems pretty certain, as certain as anything is in science, which forbids absolutes.

I don't think that whether you believe there is no risk or just a extremely small one attached to oral sex has anything to do with sexual prohibitionism... In any case you can have as much protected sex as you want. You can be sure I do

You are incredibly lucky to have not yet run up against sexual prohibitionism among the HIV+. I hope your string of luck continues...I really do.

But when I discuss this issue with laypeople (those not directly effected by HIV in their lives), the prohibitionist element becomes really apparent really quickly.

I wouldn't ever tell someone to push their limits of risk management beyond their comfort zone, and if chewing on a condom is satisfactory to you, then run with it, baby

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Oh, bring out the straw men why don't you, Bucko; it really doesn't do much for your credibility.

Using your utterly bizarre definition of 'theoretical', black holes don't exist; because their existence is theoretical and no-one has conclusively proven that they exist - yet, for some strange reason, you wont actually find many scientists who dispute their existence.

When scientists describe the risk of transmitting an infectious disease, like HIV, the term “theoretical risk” is often used. Very simple, “theoretical risk” means that passing an infection from one person to another is possible, even though there may not yet be any actual documented cases. “Theoretical risk” is not the same as likelihood. In other words, stating that HIV infection is “theoretically possible” does not necessarily mean it is likely to happen –only that it might. Documented risk, on the other hand, is used to describe transmission that has actually occurred, been investigated, and documented in the scientific literature.

So out of the millions of blowjobs a day and deep kissing that goes on a day that they come up with only a few non documented cases claiming that their only risk was giving oral sex and the hundreds of people in the oral discordinate studies that NOT ONE has ever contracted HIV from unprotected oral sex. Now which are you going to believe? A scientific study where the folks were actually tested or are you going to believe someone that said they contracted HIV by giving oral sex? After 3 decades of this infection if it were true there would be hundreds of thousands infected by giving oral sex instead of the hand full that claimed to be infected in that manner.

After 3 decades of this infection if it were true their would be hundreds of thousands infected by giving oral sex instead of the hand full that claimed to be infected in that manner.

Much as I appreciate what you are saying Rob, you aren't actually arguing against anything I have said.

As it happens, I am a medical scientist and I know exactly what 'theoretical risk' means - and it certainly doesn't mean that it hasn't happened. I am simply pulling Bucko up on his banal attempts to belittle other people, by questioning their comprehension of the English language - when in fact it is he who is guilty of redefining terms and warping them into what he would like them to mean.

If you think that is a good example, then that is up to you. I don't, because I think it undermines the rest of the argument which I believe to be fundamentally true: i.e. that the risk of transmission through oral sex is so low that it isn't even worth worrying about.

As for the "handful" you speak of, most health protection agencies quote better than 1% (some as high as 3%).

Oh, bring out the straw men why don't you, Bucko; it really doesn't do much for your credibility.

Using your utterly bizarre definition of 'theoretical', black holes don't exist; because their existence is theoretical and no-one has conclusively proven that they exist - yet, for some strange reason, you wont actually find many scientists who dispute their existence.

My credibility at AIDSmeds is not usually questioned, Finn. Good for you!

Since you're such an authority on risk scenarios, maybe you should contact the mods and ask if you can put your authority to good use in the Am I Infected forum where you can put your thinking into action with real live people dealing with their risks. There's a vacancy there now.

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Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Thanks, Tim for your reply. I do understand the "official stance" now, thank you. To be honest, I question the analogy about theoretical risk and a meteor falling on ones head. While I understand the analogy, and I understand theoretical risk, it is my understanding that the scientific community is still working on this particular issue. Instead of theoretical risk, I believe the answer to HIV transmission and oral sex is that we just do not know. We do not have enough information. I ask that it is made clear to people that we do not know for 100% sure what the risks might be.

This is a scientific article published in 2008 in the International Journal of Epidemiology. It says:

"Conclusions: There are currently insufficient data to estimate precisely the risk from OI (orogenital intercourse) exposure. The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates."

All I am saying is that people should be aware that there is a debate, and that the scientific community is currently unsure of what the risk is. It is estimated to be low-risk. As we become more educated about HIV, and as we educate the general public about HIV, the less new HIV infections we will see. That's the only reason I am bringing this up.

"ACOG notes that while generally considered low-risk for transmission when compared to receptive anal or vaginal sex, HIV cases have been linked to oral sex. "

Again, low-risk not no-risk. We can debate theoretical risk. But the scientific community is clear: we do not yet understand the risks. I for one won't gamble my partner's status on it, no matter how low the risk, until I have more information.

My credibility at AIDSmeds is not usually questioned, Finn. Good for you!

Since you're such an authority on risk scenarios, maybe you should contact the mods and ask if you can put your authority to good use in the Am I Infected forum where you can put your thinking into action with real live people dealing with their risks. There's a vacancy there now.

I worked in the medical field for many years and my defintion of "theoretical" simply means "restricted to theory, but not practical...and I agree it certainly doesn't mean that it hasn't happened, but I don't expect to be pulled up because of the way I express my defintion of a word.

I personally haven't felt "belittled" by anyone, but as Tim said this is an intreguing/informative thread, and I'm sure we can all learn a little something from it, so lets keep it on track.

made us (ann, myself and others) think you had no idea HIV could not be spread through cunnilingus. Ann provided you with this information regarding saliva:

Quote

Oral Dis. 2006 May ;12 (3):219-28 16700731 Oral transmission of HIV, reality or fiction? An update.J Campo , M A Perea , J Del Romero , J Cano , V Hernando , A BasconesHuman immunodeficiency virus (HIV) and many other viruses can be isolated in blood and body fluids, including saliva, and can be transmitted by genital-genital and especially anal-genital sexual activity. The risk of transmission of HIV via oral sexual practices is very low. Unlike other mucosal areas of the body, the oral cavity appears to be an extremely uncommon transmission route for HIV. We present a review of available evidence on the oral-genital transmission of HIV and analyse the factors that act to protect oral tissues from infection, thereby reducing the risk of HIV transmission by oral sex. Among these factors we highlight the levels of HIV RNA in saliva, presence of fewer CD4+ target cells, presence of IgA antibodies in saliva, presence of other infections in the oral cavity and the endogenous salivary antiviral factors lysozyme, defensins, thrombospondin and secretory leucocyte protease inhibitor (SLPI). Oral Diseases (2006) 12, 219-228.

The Romero study used male/female relationships almost exclusively, with either male or female partner positive. The viral loads varied widely, as did the treatment options (or lack thereof) during the ten years of the study.

The Page-Shafer "HOT" study used homosexual males with different partners, studied both receptive and insertive oral sex.

Note the methodology for the Page-Shafer and Romero studies, and how they differ significantly from earlier studies which relied on post-infection patient report. In my opinion, that methodology dramatically increases the validity of the report.

the participants of that study were all men who came to the clinic in SF for HIv testing, who reported protected anal/vaginal sex, no needle sharing/IV drug use, yet admitted (I hate phrasing it like that) to having had receptive oral sex without a condom. The setup for this study skewed the natural inclination of patients to misremember or inaccurately recount their sexual activities, as it used as a benchmark people who claimed to have had protected anal/vaginal, yet unprotected oral sex.

Were there ANY new infections detected in the study, followup interview would have been initiated to assist in determining the mode of transmission, which would possibly taint the study with the broad brush of anecdotal evidence. However, it is important to note that there were ZERO new infections in the study period, which rendered unnecessary any followup interview or speculation.

I said this in a post in March, 2007. And I believe it bears repeating especially since ap oster postulated a few reasons why people are "adamant" one way or another in this discussion/debate.

I have changed some wording to reflect the current state of affairs, therefore shall not put this in quotes.

Post-infection patient survey is exceedingly unreliable, but until the advent of HAART, there were NO serodiscordant couples remaining sexually active long enough to compile and follow. We were, at best, extrapolating from the softest science (patient report) and presenting it as hard data. While I understand that position from a "better safe than sorry" aspect, it's simply not anywhere close to the quantifiability of the serodiscordant studies.

A vested interest? Sure, because once you postulate that exposure to saliva can infect, you transition HIV from an infectious agent to a communicable one. With all the stigma and isolation that such an event presupposes.

I get so frustrated sometimes, because the science is THERE. Its OBVIOUS. And frighteningly few seem to bother to look at it.

It is obvious with simian and primate studies, with long term monitoring, with epidemiology in the heterosexual community as well as the gay community.

It's obvious with the lack of documented cunnilingus transmission, with the lack of casual contact transmission, with the long-term serodiscordant studies, and with the biological evidence of the mechanisms for HIv infection: to wit, the necessity for HIV to contact specific lymph cells and dendritic cells, which are almost utterly absent from the oral cavity.

The dozen or so proteins and enzymes in saliva which inhibit HIV (at least two of which have been synthesized and used in Astroglide lubricant).

As people with HIV, we have not only an opportunity, but a DUTY to understand our infection and the transmission vectors. Otherwise, we should not be shocked when our families and friends withdraw, when we are given plastic forks at Thanksgiving, when our hands are not held when we die.

As someone who has been an HIV educator for almost 15 years, my vested interest is in keeping the science as current and correct as possible.

As for the "theoretical versus hypothetical" thing being thrown around, I might remind people that it HAS been proven that on at least ONE and possible TWO occasions since the advent of recording/documenting such instances, people HAVE been struck by meteorites.

Therefore being struck by a meteorite is LOW RISK, but certainly not ZERO risk.

There is scant room for ZERO in science. Certainly not medical science.

I believe Tim Horn answered Sara's question rather definitively. I am rather perplexed at the condescension and flame-baiting that has ensued thereafter.

Jonathan(who will always subscribe to the philosophy "the plural of anecdote is not data"

Since there is no way to end this discussion without hard feelings, I respectfully withdraw at this point. Having exhausted my science for the moment (though I have reams on the HIV inactive properties of saliva and other studies which bear tangential relevance to the discussion) I will leave it to others to take up the slack.

To the best of my knowledge, there are no other long term serodiscordant studies currently in progress, so in that arena, the science seems to be static.

Also, I have spent the last few months transitioning from prevention/transmission science to treatment.... because I suddenly find myself with a vested and selfish interest in remaining alive, and it seems to have come to that.

« Last Edit: September 16, 2008, 06:25:34 PM by jkinatl2 »

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

But if, after tracking the evolution of the pandemic since 1981, there are no confirmed cases of transmission through giving a blowjob..

"Confirmed" is so difficult in this area. Obviously, there's no way of proving how someone got it but trusting the risk encounters they report. There are documented cases of people who claim they got it from giving oral, but obviously you cannot prove they had another risk that they didn't report. Some of them obviously underreport other risky behaviour, but all of them? I'm not gonna bet anything important on that until I have conclusive evidence.

You are incredibly lucky to have not yet run up against sexual prohibitionism among the HIV+. I hope your string of luck continues...I really do

Me too, Bucko. I hope all of us are that lucky. Sexual prohibitionism would not solve anything. After all, I think the risk of transmission, socially speaking, are not the pozies who practice safe sex, but those of unknown status who don't.

I wouldn't ever tell someone to push their limits of risk management beyond their comfort zone, and if chewing on a condom is satisfactory to you, then run with it, baby

Just for the record, I'm not the one who would have to chew on a condom, but my partner

Anyway, I was gonna ask for a link to those studies, to check them directly, but Jonathan kindly did so before I finished typing this message. I checked them, and my conclusion is the same, and I'm quoting: "The risk of HIV attributable to fellatio is extremely low" and "Our results are based on a modest sample size; therefore, we cannot rule out the possibility that the probability of infection is indeed greater than zero".

I understand there are reasons why getting a sample size big enough to reach a conclusive answer is difficult, however, given how much there is to be gained, both in terms of public health and of stigma eradication, I cannot understand why some effort is not put in this field.

Anyway, Johnathan, I don't think anyone here is supporting the idea of saliva being a fluid capable of transmission. At least I've never said such a thing: the discussion is limited to the case of receptive oral. No one has questioned insertive oral is not capable of transmitting hiv, as in that situation the negative person is only exposed to the saliva of the positive one, and all of us agree saliva is not capable of transmitting hiv. Let's not blow things out of proportion.

I do think, as some others have pointed out, this is an informative and and intriguing thread. I have not felt "belittled" by anyone (even though English, in fact, is not my native language), so I know it's quite possible to keep the thread flame free.

....as an alternative diversion, people could close their browser, pull up a deckchair (perhaps with a Jaeger rug as it's September), crack open the whisky n listen to the new Ben Taylor album.

This is an "unsolvable" topic and as I said before, which part of...? I do not discount people's personal experience (cos even 1% or a part of 1% of a million is a lot of people), the science, studies, theoretical v real n all the rest, but jeez, life is short n there's a new Ben Taylor album out.

I got HIV in April 2008 through oral sex. The guy who I sucked was in seroconversion stage. He was also impotent and before we began sex, he injected his penis to get hard. That drug was given to him by a doctor.

Anal sex was protected. Oral sex was without ejaculation. There was no sperm exchange. It can be surmised that HIV was transmitted through pre-cum and/or minute amount of blood transmission. Furthermore, my doctor said I very highly likely had oral transmission and in my throat. This is because of the way the doctor interpreted my seroconversion illness (one ulcer in mouth, ulcerated esophagus, and headache).

Also - if you must know, my partner was hung quite large, and we both used poppers but no other drugs. I searched the net and found very little evidence that this can happen, other than one study in SF that suggested that popper use may make mucosal cells more receptive to an invading HIV, and that big dicks and popper use were correlated with a very low but real HIV oral transmission risk.

So, after 25 year sticking to what I thought was safe sex, and even having had poz boyfriends, I did seroconvert and it was through oral transmission.

I can imagine this is rare and it might have been blood, not precum. We will never know for sure which.

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“From each, according to his ability; to each, according to his need” 1875 K Marx

Jonathan, I appreciate your response and respect your decision to abstain from continuing this conversation. It does not need to become personal, nobody needs to have their feelings hurt to have an intellectual conversation. Let me clear the confusion, I feel the same way about this topic that I did when we discussed it last time, although perhaps now I am better able to state my position as I have come much further in accepting my HIV status. I am not proposing that saliva is infectious, I am speaking about oral sex performed on an HIV positive partner by and HIV negative partner only.

The first study you quote from 2002 has a sample size of 135 HIV negative people. Of these, only 10% (6 people !!) had a viral load of above 10,000 copies. This is a very small sample size. We think now that lower viral load means less transmission. This study does not take the viral load factor into consideration -- or at least it does not provide us with enough cases to determine risk with certainty.

To be clear, a scientific study where most of the participants have low viral loads does not tell us if HIV can be transmitted by receptive oral sex. It tells us it is unlikely when the participants have low viral loads. How about the real world, where possibly some 250,000 Americans are living with HIV but they do not know it ? Their viral loads are likely higher than those in the study who are on treatment. When determining risk we need to take the real world scenarios into account. The current and older research has not logistically been able to do this. We need more studies for a definitive answer !!! That's all I'm saying.

Science changes quickly -- if we believed everything we thought was true about HIV/AIDS back in 2002 today we would be much more limited in the entire fields of treatment and prevention. Some studies hold up, some studies do not. Either way, I am only quoting a current 2008 study and for those of you that disagree, disagree with the authors of the study: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.

The science is not obvious. Science is rarely obvious, but instead constantly evolving-- science is alive not dead and packed away in the record books.

If he injected his cock with something and you sucked it, that's not great proof of typical oral transmission possibilities, is it?

Well, given how rarely we think oral transmission happens, there must be certain atypical factors or special circumstances that cause oral transmission to occur when it does. It would be useful to know what all or most of them are so there could be more valuable prevention information than just "oral transmission happens very rarely or hypothetically". Perhaps using one of these drugs was one of them.

Someone in their seroconversion period with a high VL would probably also be at higher risk of transmitting HIV orally to someone else if someone performs oral on them. That's the stated reason in the above case. It seems like an obvious hypothesis. I don't know if it's been verified, but it doesn't sound like something you could easily test and repeat in any study. Many people don't find out about their HIV during their seroconversion, usually afterwards, and then their VL decreases.

Another factor that's already known to increase the oral risk and listed on the AM/poz page is if the giver has openings in their mouth from recent brushing or flossing.

I read a lot about stomach and saliva acids in this thread that neutralizes the HIV from precum, semen and blood. Perhaps those taking acid reducing medications are more at risk for HIV too when giving oral ?

I am another one who thinks he was probably infected with HIV orally, but like most, I can't prove it. But I do know that I had at least one known risk factor (brushing/flossing) that I didn't know about then - I just knew that oral sex was "very low risk". I wish I had known about that risk factor before, as perhaps I wouldn't be a member of AIDSMEDS now if I did. I hope the other risk factors for oral sex are discovered too.

I have posted in other threads about my story more in detail, and I won't repeat it all again here. I'll just say that it does not feel good for your personal story to be called into question or dismissed altogether just because oral sex was not the only risk factor, which is what happens a lot around here when somebody mentions oral sex. I'm glad my doctor has a different attitude about it. I also notice that very few are stepping up to tell their own story about oral sex in this thread. I think that says a lot about how taboo the subject is.